When Therapy Is Not Working

by LeShelle Woodard, Ph.D. Originally published at Psych Central, June 2018.

How to Handle Things When Therapy Is Not Working

One of the most challenging scenarios for those seeking psychotherapy is figuring out what to do if progress has slowed, stopped or the therapy just doesn’t seem to be doing anything to support your growth. Some people handle the situation by abruptly switching therapists or dropping out therapy all together. Worse, others continue working with the same therapist blindly hoping that the process will work or drawing unhealthy conclusions about their inability to change. Psychotherapy is an important investment in terms of time, money and most importantly, your health and sense of well-being. If the process seems ineffective, take action.

Speak Up

Surprisingly few individuals voice their concerns to their therapist. In my experience in working with clients who have abruptly ended work with a prior therapist, concerns about offending the therapist, hurt feelings or damaging the relationship are significant barriers to voicing concerns. This is unfortunate, as the therapist is typically the most useful resource in addressing any concerns regarding the therapy process. Try not to be overly concerned regarding the therapist’s feelings and instead focus on your shared goal of fostering your growth. Therapists are trained to handle client concerns in a professional and productive manner. We truly share your goal of improving various aspects of your life. Therapists generally welcome feedback from clients and will appreciate learning about your thoughts, feelings and concerns.

Collaborate Regarding Your Needs and the Process

Therapy involves a specific plan of treatment that the therapist should voluntarily share with you. This will help with developing realistic expectations and to improve your sense of ownership of your goals. Throughout the therapy process, it is a good idea to ask the therapist to periodically review the plan with you so that you both can monitor your progress and to make any desired changes. The bottom line is that if your therapist and you are in agreement about your goals and a plan for achieving them, your chances of success will be significantly improved.

Check for Evidence

Throughout the therapy process it is useful to be a good empiricist. This means you should look for concrete evidence of growth. Are you noticing improvements in the areas of difficulty you identified when you started therapy? For example, are you experiencing fewer conflicts or other difficulties in your relationships? Have unhealthy behaviors decreased? Have healthy behaviors increased? Has your opinion of yourself and your abilities become more fact based instead of emotionally driven? Are key symptoms such as panic attacks becoming less frequent or less intense? If you are unsure, talk to your therapist or someone who knows you really well and is willing to provide honest feedback. Make sure that you seek feedback from someone you trust and is nurturing rather than hurtful.

Find Out if you are receiving the Best Type of Therapy for Your Needs

Discuss with your therapist about the type of psychotherapy and the specific techniques that are being used. What generally works for others, may not work for you. For example, cognitive-behavioral therapy, or CBT, is a popular therapy for resolving many difficulties such as depression. This approach may not be the best match for you if your depression is, for example, a response to traumatic stress. Traumatized individuals may be coping with a complex combination of distorted thoughts and beliefs that are combined with various types of memory and bodily responses. Effective therapy requires addressing the full range of difficulties. Similarly, if you struggle to manage overwhelmingly negative emotions associated with various beliefs, CBT’s effectiveness may be limited if such strong emotions are frequently activated in session. In such scenarios, your therapist may add additional techniques or even switch to a different type of therapy that is better matched to your particular needs. Essentially, you may receive more effective therapy and better outcomes as a result of asking questions, learning about the your therapist’s techniques and addressing any barriers that may be limiting your progress.

Examine the Quality of the Relationship

In some respects, psychotherapy is a very strange interpersonal arrangement. Successful engagement in therapy often requires sharing of intimate details about your life. At the same time, you know very little or nothing about the therapist and unlike other relationships, you are unlikely to learn personal details about the therapist as your relationship progresses. In essence, you are being vulnerable yet trusting with a complete stranger over an extended period of time. Given this arrangement, it is important to consider the overall quality of your relationship with your therapist. Clients often dismiss such questions because the professional nature of client-therapist relationship. However, such questions are not only fair but important since psychotherapy is fundamentally a human relationship. In fact, research and clinical theory suggest that the quality of the client-therapist relationship may be at least equally important as the therapist’s training and skills to successful therapy. Do you feel a sense of attunement or connectedness during session? Do you generally feel positive towards the therapist as a person? Do you sense that these positive feelings are reciprocated? Does your therapist seem genuinely interested in you? The client-therapist relationship must be intact and adequately functional to foster growth. If the therapist cannot remember your name, is nodding off, chronically uses his or own life as a key reference point in your sessions (reflecting insufficient objectivity), chronically cancels or largely seems disinterested or distracted, you have reason to question whether the quality of the relationship is a reason that your progress is insufficient.

Check Yourself before Jumping Ship

If the quality of the client-therapist relationship seems insufficient, check in with yourself prior to moving on. Are you allowing yourself to be sufficiently vulnerable? Are there important portions of your history that you have not divulged (including events that occurred long ago that you believe are no longer of relevance)? If so, have you let the therapist know that there are materials that you are not quite ready to share? Is there something about your therapist that reminds you of someone else who is associated with emotional pain or fear? If so, are you maintaining awareness of that your therapist is not the hurtful person? It is also very important consider whether the difficulties you are perceiving with the therapist also exist in other relationships. Do you experience difficulties feeling safe, attuned or emotionally connected to others? Do you tend to approach relationships as though they are a competition that you must win? Do you typically develop disparaging thoughts towards others when they fail to meet your needs? If you see a pattern of difficulties across relationships, what you are experiencing when sitting with your therapist may reflect unresolved issues. When such difficulties occur they are part of the therapy process. It is important to allow yourself the opportunity to work through such difficulties preferably with your therapist as a safe source of guidance.

Check Safety

This is a good place to state that if there are concrete reasons that you do not feel safe or good about therapy because something inappropriate is occurring during session or with the therapist, this is not a “working through” or relational issue. It is also not a self-issue. Examples include inappropriate or non-permissive physical contact, personal solicitations, inappropriate therapist disclosure (such as sexual materials, details of a divorce, etc.) or related behaviors. Depending on severity, these are issues that should be handled by setting firm limits, discontinuing therapy and if appropriate, seeking guidance regarding any ethical or legal violations of the therapist.

Gain Optimal Benefits

The bottom line is that psychotherapy is a powerful tool that can help you grow in wonderful ways. In my admittedly biased opinion, psychotherapy one of our most powerfully effective ways to take good care of ourselves. If you’ve made the investment but are unsure if therapy is working for you, take the time to actively address your concerns. Doing so, can potentially catalyze the therapy process resulting in greater growth and ensuring that you get all that you deserve and desire from the process.

About LeShelle Woodard

Dr. LeShelle Woodard is a licensed clinical psychologist and educator who, leads a team of dynamic psychotherapists in the provision of multifaceted therapies at the private practice she founded, Life Enhancement Psychotherapy. Dr. Woodard and her team incorporate an array of complementary and integrative treatments such as body-centered interventions such as yoga therapy, mindfulness and other techniques drawn from both traditional and non-western therapies. As a former Associate Professor of Psychology at Lasell College in Newton, MA ,and a Senior Lecturer at the University of Massachusetts, Boston, Dr. Woodard’s courses include Abnormal Psychology, Psychological Trauma, Intervention Strategies, Personality, Social Psychology, Group Dynamics and other courses associated with the study and understanding of human behavior.